Speech Impairment and Loss

HL Deb 16 May 1985 vol 463 cc1310-33

7.15 p.m.

Lord Campbell of Croy rose to ask Her Majesty's Government what consideration they are giving to the problems arising from loss or impairment of speech.

The noble Lord said: My Lords, I beg leave to ask the Question standing in my name on the Order Paper. This is an opportunity to discuss what is being done and what could be done to alleviate problems arising from handicaps in speech, and to hear the Government's views. I am grateful to the noble Lords and Baronesses in different parts of the House who have indicated their intention to take part in this debate. All of them possess great knowledge of the subject and are clearly concerned about sufferers from loss or serious impairment of speech.

I start by suggesting that the development of speech therapy and the production of qualified speech therapists in recent years have made a notable impact. It has proved possible to restore communication by speech in cases where it was previously thought that nothing could be done. Of course, such apparent magic cannot be performed in every case. However, the degree of restoration and the amount of improvement in cases of impairment constitute a tangible and notable record of success from this comparatively new profession of speech therapists. There is scope, I sugggest, for wider use of their skills.

The particular point I should like to emphasise today is that a considerable number of people with a wide range of disorders of other kinds, as well as in speech, can benefit greatly from speech therapy: spastics or people suffering from multiple sclerosis or mental disabilities, to give three examples only.

Someone whose legs are paralysed by accident or illness and who has to be in a wheelchair may also have a speech disorder as part of his condition. He is no longer able to communicate. It may not be possible to do much medically to improve the paralysis in his limbs, but if we are able to restore speech well enough for him to communicate, that will transform his existence. It may make all the difference as to whether he can live at home or will have to be kept in hospital or in an institution. There is a message here on public expenditure for Ministers, my Lords. Hospital and institutional care is very expensive. The cost of the availability of a speech therapy service could be offset to some extent—perhaps even totally—by success in improving a patient's ability to live in the community and so be eligible and willing to be discharged.

A key event in the short history of modern speech therapy was the publication in 1972 of the Quirk Report. The report produced evidence that speech therapy had established itself as an indispensable service, vitally important in a large range of conditions, and that the demand for speech therapists far exceeded the supply". It recommended expansion and set target figures for numbers of speech therapists in relation to the population: namely, 12 therapists per 200,000 of population.

I was a Health Minister at the time, as Secretary of State for Scotland, and I saw action started on that report. I am glad that in the 12 years since then significant progress, based on the Quirk Report, has been made. In some areas of the country the target figures have now been reached. My submission today, however, is that still more needs to be done to provide wider availability of speech therapy. More people can benefit by cure or improvement than was imagined or contemplated in the past. Speech therapists have shown by results what can be achieved in restoring and improving ability to communicate.

I should explain that long before the Quirk Report my personal interest was engaged. I spent more than a year, 40 years ago, in the hospital ward of a leading neurosurgeon. Many of the others in the ward were head cases, mostly from shell and mortar wounds. I got to know the speech therapists and saw them at work with men who had brain damage and, in one case which I remember particularly well, complete loss of memory. At this point I should perhaps make clear that I was not myself a head case, though some of my uncharitable friends may be surprised. The surgeon was operating on my back, a bullet having gone through my middle—incidentally, nine days before VE Day which we have recently been commemorating. I do not conceal my admiration then and later for the skill and patience of those speech therapists and their successors.

Turning to more recent times, within the last three years a new organisation has been formed bringing together various voluntary bodies which are concerned with particular diseases or disorders. It is named Voluntary Organisations Communications and Language, which felicitously produces the acronym VOCAL. It now has 28 constituent members as diverse as the Parkinson's Disease Society and the Downs Children's Association. The important common factor for all 28 of these voluntary bodies is that many of the people they cater for have, besides other handicaps, loss or serious impairment of speech. Another member of VOCAL is the Royal Society for Mentally Handicapped Children and Adults, known briefly as MENCAP. I am very pleased that my noble friend Lord Renton, who is president of MENCAP, is proposing to speak in this debate and he will no doubt say more on that subject.

At least two other member organisations are concerned with handicaps resulting from strokes. Where speech is seriously affected by strokes, remarkable improvements can be made. It is estimated that about 10 per cent. of the survivors of strokes have severe impairment of speech. Those who could benefit from speech therapy do not all at present have access to it. I believe that the noble Lord, Lord Smith, will say more on this. I am delighted that he has put his name down to speak in this debate, being a former president of the Royal College of Surgeons of England.

VOCAL took part in a survey completed at the end of 1983 into conditions and needs of speech therapists in the National Health Service. It was largely carried out by obtaining replies to a questionnaire from speech therapists in the country who are members of the College of Speech Therapy. The response was good and informative. Among the conclusions from the survey are these. There is a need for speech therapy and it has increased since the Quirk Report was published, notably in the fields of mental handicap and categories of small children who have speech difficulties before school. Another conclusion was that more knowledge of what can be achieved should be spread throughout the National Health Service and higher priority should be given to speech therapy in providing opportunities to restore normal communication for patients who have lost the power of speech.

Today there is another matter which must be raised; that is the training and placing of students. Recently there has been a revision of student training and allowances. Apparently there was no consultation with the College of Speech Therapists. It has led to a less satisfactory situation. In particular, the system of block placement has ended; that is a description of the stage where a student spends three of four weeks working with a qualified speech therapist

I ask the Government to look carefully at this with a view to restoring clinical training places and the allowances. This should be the best way to provide the therapists needed to meet future demands. We should beware of false economies. If patients can regain the ability to communicate by speech, even though disabled in other ways, they can return to a fairly normal life in the community. Again, as regards children, if speech therapists are available at an early stage they can reduce or obviate the need for expensive care and treatment later in life.

It might be thought wholly inappropriate for this subject to be raised in your Lordships' House. Everyone here is very articulate and fluent and has no need of speech therapy. Indeed, I must confess to the mischievous thought I have sometimes had at times, both here and in another place, when one of my long-winded colleagues has been in full spate, that providence might intervene with a sudden loss of capacity for speech—of course only a temporary loss. Be that as it may, we can all visualise the frustration and complete disruption of someone's life which loss of speech causes.

I ask the Government whether they will direct more attention to the need for speech therapy and to the ways in which it can most effectively be met. This includes wider availability within the National Health Service and greater awareness of that availability, and of the potential for improving the conditions of patients in many varieties of cases. It also includes the vital matter of devising the best and most suitable system of training for this essential profession of speech therapists. I look forward to hearing from my noble friend Lord Caithness who, I am very glad to know, is to reply from the Government Front Bench.

7.28 p.m.

Lord Ennals

May I say first how much all of us feel indebted to the noble Lord, Lord Campbell of Croy, for raising this extremely important issue and, equally, for having attracted, in what will inevitably be a short debate, so many people of experience and skill from whom I know we shall all learn. May I also congratulate him on the timing of this debate, because it is of course National Deaf Children's Week and nothing could be more appropriate than that we should be discussing this subject during this week, though there are problems which go beyond those children.

It has been estimated by the Department of Health and Social Services that more than 4 million people in Britain have significant hearing loss. About one child in 1,000 is born with severe hearing loss, so the first priority is obviously prevention. This includes genetic counselling, better ante-natal and peri-natal care, treatment of upper respiratory and other infections and vaccination of mothers against rubella, as deafness in infants can be related to rubella. One wants to give maximum support to the national council which is campaigning for children to be vaccinated against rubella, and I think it not inappropriate to say how much one appreciates the support of the Princess of Wales in this connection. The publicity gained cannot but have a good effect on the public.

It is not always possible to prevent deafness, which makes it important that any impairment is discovered as early as possible. Emphasis continues to be placed on the need to screen children at an early age—perhaps around eight or nine months—so that action can be taken quickly to diagnose, to assess and to treat any child in whom hearing loss is suspected. New equipment has been developed which is opening up prospects of effective tests on babies before they leave hospital. I think that we would all want to welcome that development.

I am fortunate in contributing to this debate not so much because of my own personal knowledge but I have in my family two trained speech therapists. I have a son who is a development officer with SENSE, which is concerned with the deaf, blind and rubella handicapped. I have another son who is concerned with computers and the expanding means by which they can be used in a communication sense for disabled people. So if I do not say the right thing I shall be in trouble with about half of my family.

I should like to start first with the provision of radio hearing aids, which was not touched on by the noble Lord, Lord Campbell of Croy. Acquisition of speech and language for deaf children depends very greatly on the level of their hearing loss and on the adequacy or otherwise of the hearing aids. The National Deaf Children's Society is particularly concerned about the shortfall of approximately 50 per cent. in the provision of radio hearing aids for children. At the present time only about 25 per cent. of children wearing hearing aids have the use of a radio aid. Forty per cent. of these radio aids have been bought by charities. I think that this is a useful reminder of the important role of charities, which in another sense we will be discussing on Monday.

It is true, and this was confirmed by the National Deaf Children's Society, that roughly half of Britain's 30,000 deaf children are losing out educationally in their battle to acquire speech because they do not have a radio hearing aid. This is just one aspect of what the National Deaf Children's Society called the "communication jungle" which now exists in Britain. One of the main findings of the survey carried by the society was that 80 per cent. of parents, and 81 per cent. of professionals, desperately wanted more information about new technology for deaf children.

Radio hearing aids have revolutionised life for the deaf children who have them. In particular, they have been the single largest technical contribution to the integration of hearing-impaired children into ordinary schools: they provide a direct link between a deaf child and the teacher in a class of hearing children. At the same time, they have also helped these children to acquire speech and language at home, because they provide a sound link with their families even when they are moving about at a distance". However, while an ordinary hearing aid has to be provided by the National Health Service, there is no statutory provision of radio aids. I am raising this point particularly—and I am raising it early in the debate—in the hope that the noble Earl when he comes to reply will be able to say something about it. At present the provision of radio aids is left to charity, to parents, if they have the money to do so, and to the enlightenment of individual local education authorities, if they have the funds and wisdom to provide them.

The director of the National Deaf Children's Society said just a few days ago: It is unjust that a few deaf children benefit from the tremendous help these radio aids can give, whilst the rest have to struggle without them. We would like to see statutory provision of radio aids for all hearing impaired children who need them. We estimate that the cost of providing radio hearing aids would be £2 million initially, with as little as £200,000 annually to service and maintain them. This is only 1.6 per cent. of the existing NHS hearing aid budget". So we are not talking about a massive sum of money. He went on to say that, things are going to get even more complicated and confusing in the near future. In the United States and Canada for instance provision of telephone services for deaf people is about 15 years ahead of us". We ought to be applying the new technology which now exists to those who are so seriously deprived.

My second point, which was very properly raised by the noble Lord, Lord Campbell of Croy, concerns the provision of speech therapy for deaf children. There is no doubt that a hearing loss has a profound effect on speech development. Those of your Lordships who heard the presentation by a number of, let us say, smaller organisations of disabled people last week were very much aware of the difficulty that someone with a hearing defect has when presenting his case to a significant number of your Lordships.

Teachers of the deaf and the blind are trained in speech and language work with deaf children. Speech therapists with experience of hearing impairment have a special contribution to make to the assessment and development of speech and articulation. The proposal that had been made by Sir Keith Joseph to withdraw the mandatory requirement in terms of teachers of the deaf and the blind was, as a result of all-party pressure, fortunately withdrawn. We are faced here with a very serious problem in terms of the shortage of speech therapists and the training of speech therapists.

I received a letter, which I shall quote, from Heathlands Primary School for Deaf Children. They wrote to me only yesterday and I received the letter today. They knew of the debate which was to be initiated by the noble Lord. I shall quote the letter from the headmistress: Heathlands is one of the special schools hit especially hard by cut backs over recent years in the Health Service. Eight years ago the school asked Area Health for Speech Therapy for Heathlands pupils. Finally after much hassle … we were given three sessions a week (1½ days) to divide between 50-odd pupils. The Parent Teacher Association, in desperation, realising that nothing would be done for a whole generation of pupils, decided to employ a fulltime Speech Therapists' Aide to work under the visiting Speech Therapist. The School now has a roll of 89 pupils. The P.T.A. has to fund a salary currently of £5,000 annually"— a considerable sum to be raised by a Parent Teacher Association. The letter continues: Continuing representations to District Health (since yet another re-organisation) has still not seen any improvement in staffing establishment for Speech Therapy. Since the '81 Education Act it is now law that non-educational provision for the handicapped should be provided by each District. Despite this there is still no improvement. In fact the Speech Therapist who desperately wanted to work fulltime with profoundly deaf children has now left to work in another area, so, Heathlands now has no speech therapist at all! Co-ordinating services for the hearing impaired seems to be very patchy … I.L.E.A have a fulltime Speech Therapist for each school"— she was comparing that with the position at Heathlands. The letter concludes: I do hope that the legal requirements of each child's special educational needs, under the new Act, can at least be met". I hope that the noble Earl the Minister will have something to say on that issue as well.

The third issue I want to raise concerns those who suffer from both deafness and blindness. I am of course interested in the work of the National Association for Deaf-Blind and Rubella Handicapped. I am told that for many years that association has been protesting that there is no specific training course available—let alone mandatory—for teachers of deaf-blind children, despite the widely acknowledged fact that they are some of the most difficult and demanding to teach.

Your Lordships, to appreciate that argument, need only give some thought to the plight of the deaf-blind child—or adult, although they are mostly children—who is both deaf and blind. The problems of communication are enormous. Until a few years ago, the majority of such people were to be found in hospitals for the mentally handicapped—totally unsuited, as there was no reason to believe that someone who is deaf or someone who is blind is in any way mentally handicapped.

Historically, deaf-blind children have been left out of the planning of the Department of Education and Science. Recent consultations concerning education for the blind and for deaf children failed to consider education for deaf-blind children. It was only through the action of the National Association for Deaf-Blind and Rubella Handicapped that the DES agreed to carry out a separate consultation. This has not yet been reported.

I will conclude by expanding a little further on this point. There are a number of universities at which teachers can undertake a further qualifying year for teaching hearing-impaired children, and there is one university at which teachers may qualify for teaching the visually impaired. Moreover, it is conditional upon accepting a post in special schools for these disabilities that teachers who are not already appropriately qualified undertake to pursue the training within three years, either through in-service courses or by attendance at one of the universities. Thus one can guarantee that most hearing-impaired and visually-impaired children are taught by appropriately qualified teachers. I am sure that objective is one we would all want to set.

I should like to quote a statement recently made by Mrs. Jessica Hills, who is chairman of the National Association for Deaf-Blind and Rubella Handicapped. She said: Is it not then extraordinary that dually sensorily-impaired children, who surely need even more highly qualified teachers with an understanding not only of techniques for the deaf and the blind but also for the specific problems caused by the combination of the two disabilities, should not be protected by law in the same way? Only a very few teachers working with dually sensorily-impaired children in this country have the full qualification which is unobtainable here. These teachers either qualified in the USA or Australasia. The Association has contributed towards the costs of two teachers going to the States for training". I mention this statement because it suggests that in the case of children who are handicapped in one way or another—and particularly speech-handicapped children—we are slipping behind. If that is not so then I am sure the Minister will give the House some assurance.

If the Minister is not in a position at this moment to comment on the three rather detailed points I have raised, perhaps he will take the opportunity that has been provided by this debate initiated by the noble Lord, Lord Campbell of Croy, to arrange a confidential discussion and consultation between those involved and Ministers, to deal not only with the questions I have put but also the points which other Members of your Lordships' House will raise during the course of this debate.

I repeat how grateful I am to the noble Lord, Lord Campbell of Croy, for raising this issue and providing an opportunity for this House to consider the case of children and adults who are very severely handicapped.

7.45 p.m.

Earl Attlee

My Lords, speech—possibly after touch—is the most basic of all forms of communication. I join with the noble Lord, Lord Ennals, in congratulating the noble Lord, Lord Campbell of Croy, for initiating this debate this evening.

In my maiden speech in your Lordships' House in December 1983, I explained that I was dyslexic and described some of the pressures that condition placed me under when I was a child. When I make speeches outside your Lordships' House I nearly always mention the fact that I am dyslexic—not, I hasten to add, to attract sympathy but for a very different reason. I find that after making such a speech, members of the audience will come up to me and say, "I am awfully grateful that you mentioned you were dyslexic because my son (or daughter, or grandson) is dyslexic. It helps when public figures stand up and admit that they, too, suffer from that handicap".

At one meeting I found myself addressing a group of true blue Tory ladies. Afterwards, about five of them gathered around me. I will not say that they were an adoring bunch but they were very nice. Certainly this was not because I had convinced them of the joys of being part of the Alliance in your Lordships' House, although I had been speaking about the way in which your Lordships' House functions. The point is that each of those ladies had a relative who was dyslexic.

Furthermore, my hostess on that occasion told me that she was a governor of a local well-known fee-paying school for girls; actually, she pronounced the word "gels". She explained that because one of her relatives was dyslexic she had asked the headmistress of that school how she approached the problems of pupils who were dyslexic. The headmistress had replied, "We don't use that word in this school. We prefer to call such children lazy". This is 1985, my Lords—not 1895.

The dyslexic child cannot spell and so has to look up words in the dictionary, if he can find them. The child may use that word once and then within half an hour, or an hour, or even a day later—if the child wishes to use the same word—he must look it up again in the dictionary—and so on for the rest of his life. The dictionary owned by a dyslexic person is always, like mine, very well thumbed. One may compare that situation with that of a non-dyslexic child, who will simply look up the word in the dictionary and then memorise it. The ordinary child will probably never need to look up that word again. So one could say that the normal, non-dyslexic child is really the lazy child.

I mentioned dyslexia in this context because when dyslexics muddle up words in their minds, the same muddle shows itself in their speech as well as in their writing. The actress Susan Hampshire, in her book Susan's Story, describes what happened when she was asked to present a large cheque to a pools winner. She began by congratulating the winner and then said, "I'm happy to present him with a cheque for £696". There was dead silence. Miss Hampshire was a little surprised because she had in mind a huge sum of money. She tried again and said, "I mean, a cheque for £6,096". At this, there were mutterings all around her. In desperation she said, "This cheque is for six, zero, zero comma, six, nine, zero pounds". Someone grabbed the cheque from her and said, "The amount is £600,690". I wrote it down incorrectly myself.

Dyslexia is one of the minor defects. Another is stammering. As I admitted to your Lordships, I stammered when I was a child. I worked for the Barnet Volunteer Bureau. I took a young lad who, unfortunately, had no legs back to where he had been brought up in a Dr. Barnardo's home on the other side of London. When we arrived he was greeted by a little boy, and they chatted away. I did not understand a single word that this little boy was saying to my passenger—not one word. I realised that it was as if he were speaking in a foreign language which my chap had learned and I had not. I have a very strong feeling—I think the noble Lord, Lord Ennals, touched on this—that the average person listening to this little boy talking would have said he should be in a mental hospital, that he is a loony. But he is not a loony. I do not know from what he was suffering but he had an inability to speak normally and I do not think even the speech therapists could have done very much to help him.

The noble Lord, Lord Ennals, mentioned deafness. What he said is very true. What worries me is that there is selective deafness where it might be that one is deaf to low-frequency sounds or to high-frequency sounds. One can have a child in a school who can understand one teacher perfectly but cannot understand another teacher who is speaking on a different frequency. I give an example. I worked for an oil company and we installed oil-fired heating in an old lady's house. She complained very bitterly and we went to see her. She said that the noise of the central heating pump was driving her crazy. We went into the kitchen and listened, and it was absolutely silent.

I said to my colleague, "You stay there and mess around and I will talk to the old girl". The engineer came back a few minutes later and said, "I can't find anything wrong". The old lady said, "I should think not; all you have been doing is switching that damned thing on and off all the time". I said, "You can actually hear it?", and she said, "Of course I can". We took out what to us was a very quiet central heating pump and we installed one that when we switched it on groaned and rattled and chattered. "Ah, that's perfect", said the old lady, "not a sound". She was susceptible to very high-frequency noise, and provided the noise of the pump was low it did not affect her. I felt guilty because I thought she was being stupid. I could not hear the pump; therefore why should she? But obviously she did.

I agree with the noble Lord, Lord Campbell of Croy, that we need more speech therapists. In my maiden speech I mentioned talking to a lady in the Press Club who said to me, "You used to stammer, didn't you?" It turned out that she was a speech therapist. So they are obviously trained, and we need more of them.

In conclusion, I hope that the Government will bear this in mind because it seems to me such a crying shame that young children are classed as being mental and are put into homes where no one ever tries to teach them because they think they are unteachable. But although they may be brain damaged they do have a fair degree of intelligence—it is just that we do not happen to speak their language.

7.55 p.m.

Lord Smith

My Lords, I must first, as it were, declare an interest at the start of my short speech. I know to my cost about loss or impairment of speech and its treatment at the present time and in the future. Therefore I ask your Lordships to bear with me while I deal very briefly with a piece of personal history, because it is highly relevant to the debate.

Four years ago, as a result of the blockage of a minute artery supplying the speech area in the brain, suddenly my speech was reduced to nil—literally nil. My wife and I had to start with "A", "B" and "C", working with a mirror to adapt my mouth to resemble hers in the sounds she made. My thought processes were in every sense normal. For example, I could play chess normally but I could not say "check" let alone "checkmate". I thought normally but could not translate my thoughts in terms of speech.

Quite by chance my wife and I were introduced to the volunteer stroke scheme, directed (bless her heart), by Valerie Eaton Griffith, who taught that supreme actress Patricia Neal to speak again after her stroke. Valerie started something for the future which she could not have known at the time would be of fantastic benefit to sufferers from the loss or impairment of speech. Within a few days a number of volunteers were visiting our house and each one of them spent an hour or more encouraging my thoughts to have an expression in language. In the beginning it was a word or two, and later a sentence. These wonderful volunteers were part of the service provided by the Chest, Heart and Stroke Association. In this association, Lord Hill was the chairman of the council; later Lord Cameron whose death we mourned recently.

I personally think that victims of chest and heart complaints are very well looked after by a variety of organisations, but there is a yawning gap in the treatment of victims of a stroke, particularly of a stroke which destroys the means of communication. The victim of a stroke of that kind is bereft of any communication with wife, husband or friends, which induces a mood almost suicidal; and the wife or husband very nearly gives up the struggle, surrounded by obstacles which he or she could not imagine being imposed on him or her.

One imagines that doctors might help, but consultant neurologists in hospitals are too near the problem and they transfer the patient to his home the moment the emergency is over. The general practitioner has no time to attend to the painstakingly slow improvement of stroke victims. Nevertheless, neurologists and general practitioners have welcomed the use of the volunteer stroke scheme and are very willing to work with it. But these volunteers cannot do everything; and they need instruction and control in their use.

A specialised group of speech therapists has been developed with the aim of treating aphasia patients resulting from a stroke. Ideally speaking, every patient who has suffered a stroke and as a result has a loss or impairment of speech should be treated by a doctor on general grounds, a speech therapist specialising in aphasia and a group of volunteers. In this chain of three the weakest link is in the middle. Doctors are adequate to deal with the situation. The volunteers are rapidly increasing in number, for the wish to help the victims of adversity is still strong in most people; but we need more speech therapists to co-ordinate this chain of three.

With the modern thought about loss or impairment of speech we know the way they should be treated. With enlightened and progressive thought in their management, the victim will be prevented from sinking into apathy and in danger of dying in a mood of depression. The victim of a stroke can be given the first real hope in the struggle for survival and can, with luck, and with proper help, achieve a remarkable degree of recovery. I know that from past experience.

I have to confess that my impromptu speech is not brilliant and I have to speak from notes today, but I have succeeded the noble Lord, Lord Hill of Luton, and the noble Lord, Lord Cameron of Balhousie, as chairman of the Council of the Chest, Heart and Stroke Association, and I speak to your Lordships today in support of the wise words of the noble Lord, Lord Campbell of Croy, in the hope that the Government will pay due regard to what his Lordship has said.

I must end on a brief personal note. I thought that the making of a speech within the House would be very much of a trial but your Lordships have listened to me with great forbearance and with the kindly atmosphere for which the House has always been famous, and my fears have evaporated. I speak nevertheless from emotion in the hope of persuading your Lordships that in the management of those smitten with a loss or impairment of speech we could do better.

8.3 p.m.

Baroness Lane-Fox

My Lords, it is inspiring to follow such a notable example of recovery as portrayed by the noble Lord, Lord Smith. Any of us who have just heard the noble Lord must be affected by his words. The lack of ability to communicate with anyone is a dreadful situation. Like many others in your Lordships' House I have seen the effect, both in an out of hospital. With the victim almost like a drowning figure, one instinctively longs to reach out and help. The wonderful volunteer service referred to by the noble Lord, Lord Smith, gives us great hope.

Many noble Lords in this House will know the story of Miss Diana Law, MBE, struck down and helpless by an early stroke. She heard with perfect comprehension conversations across her hospital bed to the effect that she would never in any way be active again. After some years such an idea was proved to wrong. Due to the loyal determination of her family and friends, the skill and persistence of her speech therapist and her own tenacity and courage she has made a remarkable partial reovery. She has helped in many ways countless people in the United Kingdom, and yet more people overseas during her extensive journeys abroad, by forming clubs in which people who are learning to speak again gang together to get better. For those cases it is always the speech therapists who are so important. I am told that with grown-up cases really rewarding results can be achieved by intensive and concentrated treatment.

My noble friend Lord Campbell of Croy listed some of the causes of these conditions: accidents, illnesses, strokes, all calamities that can happen too easily. What is owed to those who suffer any of those conditions is that they be allowed the treatment known to hold the key to unlock them from their imprisonment. Trained and dedicated speech therapists are the people who can really help. Diana Law founded Action for Dysphasic Adults, called "ADA" for short, of which a number of noble Lords are vice-presidents, and I am proud to be one. Her work and example deserve our admiration and support. While Diana Law deals with adults with impaired speech Mrs. Browning founded the AFASICS, which stands for the Association for All Speech Impaired Children. Through her success with her own son she has devoted her life to enthusing others with the urgent need to retrieve children from the maze of lack of communications. Again, the need for speech therapists is the first priority.

An outstanding feature in this field in recent years is the voluntary effort to help, and the excellent organisation referred to by my noble friend called VOCAL. That indeed gathers together the combined effort under the heading of Voluntary Organisations for Communication and Language, and with about 28 bodies affiliated they are a strength, doing admirable work; and the main thrust of their very vocal message always is the need for more well trained speech therapists. Here are 28 bodies who are ready to sink their individuality to put across their combined message.

All these points reinforce the plea already made by the College of Speech Therapists for more placement of students for clinical training. Once a method of treatment has been discovered for this at least humiliating and at worst imprisoning disorder, treatment depending so much on the trained skill of the therapist, surely it is up to society to increase its chance. I support the Question so aptly initiated by my noble friend Lord Campbell of Croy and appeal to the Secretary of State to recognise this as a most necessary item for the list in his readjusted health programme.

8.9 p.m.

Lord Henderson of Brompton

My Lords, I too should like to express my gratitude to the noble Lord, Lord Campbell of Croy, for asking this Question this evening, for many reasons and for one in particular, that he and I both suffered the same kind of injury much the same period ago, in my case 41 years, and I think in his case 40 years; and both of us had the same experience of being put into mixed wards where we saw at first hand, that long ago, speech therapists at work. That is something one will never forget because it is a quite distinct and special gift and a training which I have valued from that day to this.

Secondly, I should like to thank the noble Lord because he brought to the fore this admirable organisation known by the acronym VOCAL to which the noble Baroness, Lady Lane-Fox, has just referred. Twenty-eight bodies have, so to speak, sunk their differences, though they all have the things in common which bring them together, and have been able to co-operate in that way. That is one of the things which I am hoping may be achieved—it has already been achieved by VOCAL, but in other spheres—if the idea that I have for a national council for disability gets off the ground. This kind of pilot scheme of VOCAL is something which I very much had in mind and which I hope will be followed in other spheres.

The noble Lord, Lord Campbell of Croy, must feel that this debate has been worth while alone for the remarkable and moving speech by the noble Lord, Lord Smith. To have attracted the noble Lord and given him the courage to get up on his feet to give us this remarkable demonstration of restored speech is an inspiration to us all and especially, I think, to those who remember the noble Lord, Lord Smith, and his splendid utterance—which remains unimpaired —before this calamity happened to him. For that reason alone the debate has been of the most remarkable value.

Enough has been said by the noble Lords, Lord Campbell, Lord Ennals and Lord Smith, to convince everyone who has attended the debate that there is an undoubted shortage of speech therapists. I may be wrong about this, but there seems to be a shortage of candidates, a shortage of training facilities and a shortage of posts for those who are trained. In the most difficult cases the therapist-patient relationship should be one to one, but in less difficult cases, as the noble Lord, Lord Campbell, said, the provision of speech therapists may save money for the state if those who are cared for in homes can be taken out of those homes and visited by speech therapists or can attend classes conducted by speech therapists.

I think that one of the reasons why there is a need for more speech therapists is the very point which the noble Lord, Lord Smith, made. Although the numbers of those who suffer from dysarthria (people who find difficulty in producing speech) have been known more or less exactly for some time, by contrast, it has been found that the numbers of those who are dysphasic or aphasic (people who either cannot speak or find difficulty in producing speech) are very much larger than had hitherto been realised, especially as it is a common condition after a stroke. That alone may be one of the most powerful reasons for recruiting more candidates for speech therapy and increasing training facilities.

I would say that those who go in for that profession will not be disappointed. It is a profession supplementary to medicine that requires intelligence, sensitivity and patience of a high order. I believe it to be one of the most difficult, as well as one of the most rewarding, of therapeutic skills to acquire. I should like to ask Her Majesty's Government what they are doing to encourage young people to become speech therapists. What are they doing to provide training facilities or to expand those facilities and to provide enough posts for therapists when they are qualified? There is certainly a current shortage.

Then I should briefly like to touch on something which the noble Lord, Lord Ennals, has already touched on, and that is the supply of electronic aids—either the kind that he mentioned which may suit a number of people, or specially adapted electronic aids for impaired people. I think that this is a somewhat neglected area. What is needed is not just electronic equipment which can be used by a number of people with the same condition, but a laboratory which can design specially adapted electronic equipment. That should not be neglected, as I believe it now is.

On the other hand, I should like to congratulate the Government because I believe that the department has set up a number of centres where people with impairment may go. That is surely something on which the Government deserve and ought to receive congratulations.

I should not like to leave the subject without making special mention of the importance of ascertaining the level of intelligence of those suffering from the loss or impairment of speech, whether dysarthric or dysphasic or aphasic. That of course occurs where people have multiple handicaps, as was mentioned by the noble Lord, Lord Ennals. Interesting work is being done at the RHHI in Putney by Dr. Sarah Wilson—that will be of interest to the noble Lord's son, and he may already know about it—with computer-based equipment which is used where standard equipment for ascertaining the level of intelligence cannot be used. By means of visual and aural equipment significant information may be obtained about patients by their replies which are neither verbal nor written. Such information is of great value for therapists treating such patients.

I should just like to mention that on this very day there starts at the RHHI in Putney the sixth seminar on the ascertainment of the level of intelligence of severely impaired people, under Dr. Sarah Wilson. I should like—and I hope I can count on the House to join me—to wish every success to those deliberations at Putney in the following days.

8.17 p.m.

Lord Renton

My Lords, may I first endorse what the noble Lord, Lord Henderson of Brompton, said? A national council for the disabled, about which we all know he is so keen, would have the advantage of helping if it were to take on board this very important question of speech therapy as well as all the other matters that he has in mind for it. I should also like to endorse the tribute that he paid to the noble Lord, Lord Smith, on the triumph with which he overcame his impairment of speech and made it temporary. I also thank my noble friend Lord Campbell of Croy for his initiative. Having for many years been involved with the problems of mental handicap, I know that this is one of the most difficult of the problems of mental handicap.

Although, as has been said, we need many more speech therapists, I think, and I fear that we must assume, that for many years we are unlikely to have enough of them. Finding more people with the aptitude and, as the noble Lord, Lord Henderson, said, the patience and dedication for this work is not easy. When found they have to be specially trained—not only in general speech therapy but also to teach the mentally handicapped how to speak.

It is not too difficult to help a normally intelligent person to overcome a stammer, but it is very difficult to get a person with a low mental age to talk when she is reluctant to try, or is incapable of doing so. I know that because our youngest daughter, who is over 30, cannot talk at all, although—thank goodness!—she seems to understand a lot. However, in the case of many of the mentally handicapped it is not easy to get them to say a word.

A very strange factor is that there are children and young people who have been incapable of communicating with human beings and have uttered their first words when on the back of a pony or a horse. That is a serious and practical situation. I am very glad that this idea of riding for the mentally handicapped has taken on. I should like to pay tribute to a man who has done it very much on his own, although under the aegis of MENCAP, Mr. Joe Royds. He has spread the gospel and got many young people speaking for the first time. Having first communicated with a quadruped, they have been able to lead on from there.

From my experience of MENCAP, I say that enormous progress has been made with the help of all kinds of people in helping the mentally handicapped. The best time for giving help to mentally handicapped people is during early childhood, starting at a time when a normal child would be learning to speak. That is a very early stage. During the school years, regular intensive work is required. Even after a young person has left school, the work will have to continue because in some cases it takes years. For real success, I am advised that a 10 or 15 minute session in school is needed every day and should be backed up by a properly structured programme, carried out by the teachers in the school, even if they are not specialists in speech therapy, and by the parents at home.

It is obvious that we have to make the fullest use of the time and talent of such speech therapists as are available. It becomes all the more imperative to do so because of the shortage of them. There are three ways in which the speech therapist can work. One way is by teaching individuals in their homes. That of course is the counsel of perfection—although quite a lot of it is being done. However, I suggest that that takes up too much time in travelling on the part of the speech therapist. Although that way is valuable, we should not regard it as a general rule in practice.

The second way is by teaching individuals separately at a clinic, a centre, or at a special school. That is obviously a very good way. The third way is by teaching groups of people collectively at a centre. This has both its advantages and its limitations; but where it is feasible, as it is for many who have reached a certain stage in the development of their speech, it is a very good use of the therapist's time.

As has been mentioned by my noble friend and by other noble Lords, speech therapy and the training of therapists has so far been the responsibility of the Department of Health and Social Security. It has been regarded as a health problem. I suggest that that is wrong and it is time that we changed it. I hope that my noble friend Lord Caithness will take this on board. This work of speech therapy is so much involved in the training at special schools, which are the responsibility of education authorities, that it should be regarded as an educational matter.

I really cannot think why this was not done in the early 1970s when the training of the mentally handicapped generally was handed over from the Department of Health and Social Security, where the noble Lord, Lord Ennals, played a distinguished part, and was taken over to Education. That was when the Prime Minister was the Secretary of State for Education. It was very good that she accepted that responsibility. However, it is now time for us to put the speech therapists under this aegis.

I do not want to make too much of this because I have not personal experience of it but I am advised that there are a number of occasions when there has not been sufficient co-operation between health authorities and education authorities to ensure that the special schools are receiving the help that they need. This is a matter which should be inquired into. I cannot give enough of the facts and figures about it tonight. I am merely alerting the Government to this factor.

Lord Ennals

My Lords, I am grateful to the noble Lord for giving way. Will he agree that it is really almost as important to ensure that we have the teachers who are trained, as it is that we have the speech therapists?

Lord Renton

My Lords, I said that the work of speech therapists and the training of speech therapists should become an educational responsibility under the Department of Education and Science. I agree entirely with the noble Lord. Perhaps I may say a little more about the position with regard to the mentally handicapped. In most special schools 90 per cent. of the mentally handicapped children need speech therapy. That is a very high proportion. At present, the best that most speech therapists are able to manage are group sessions for several children and an advisory service for the teachers who try to carry on the work started at the group sessions during the rest of the week. That is helpful but is is not good enough.

For the handicapped child who has been integrated into the main stream of education, the picture is even more bleak. If he needs speech therapy, he will probably have to attend a clinic and thereby miss a whole morning, or even a whole day, each week from school. That is clearly something which he cannot afford to do.

Perhaps I may say in passing that I have always opposed the integration of mentally handicapped children into the general system. I know that there are many of those working in the field of mental handicap who think that this is the right thing to do. I do not find that parents take that view. It is some of the over-enthusiastic workers who, I think in a way fir idealistic reasons, reasons of moral principle almost, think that the mentally handicapped should, wherever possible, be integrated into the general system. However, where speech therapy is concerned, that is adding to their difficulties instead of solving them.

This is a big subject. Many interesting speeches have already been made, and I do not think that I can add to them. However, I believe that one should express one's gratitude to my noble friend and to all those who have spoken since then. I conclude by saying as others have done, that a considerable increase in the number of speech therapists is long overdue if they can be found. Anything that the Government can do to overcome the shortage would be good work.

8.30 p.m.

Baroness Masham of Ilton

My Lords, I, too, would like to thank the noble Lord, Lord Campbell of Croy, and to say what a most interesting debate I feel this has been. It is a most important subject, for tonight we are discussing the problems of people who may themselves have great difficulty in expressing what their needs are. One morning some years ago, I woke up and I could not speak. It was for only a few moments, but it gave me a tiny insight into the fear and frustration that people who suddenly lose their speech must experience. I was luckier than the noble Lord, Lord Smith, and I, too, should like to congratulate him on his splendid achievement in getting his speech back to normal.

The Charter for the '80s, proclaimed by Rehabilitation International, says that each nation should have a programme to prevent as many impairments as possible and to ensure that the necessary preventative services reach every family and every person. To reduce the risk of having a stroke is so important. People should be able to have their blood pressure checked periodically. If they have high blood pressure, this should be treated and monitored every three months. Prevention is so much better than cure as there may not be a full cure for many. The shock, depression, expense and tragedy should be avoided if at all possible.

Are we, as a nation, doing enough in health education? Do we eat the correct food? As has been said, once a stroke has happened, rehabilitation is necessary. It can be a hard, long slog. Those who have a speech defect need the constant skill of speech therapy, and it has been encouraging over the last few years to see how stroke clubs have sprung up. They can be helped greatly by volunteers. But there should be professional support available by a speech therapist. There just do not seem to be enough speech therapists. The ones I have met have all been very well educated, attractive, motivated, patient and skilled women—just the sort of people who get snapped up by men and marry. Is this one of the reasons why there are not enough, or is it that there is not enough money to pay for their valuable services? There always seem to be waiting lists at the schools as so many people wish to become speech therapists.

Does the Department of Health and Social Security have a full-time speech therapist in the department as an adviser? If not, I am sure that this is necessary to help the needs of speech defective people and to enable treatment to be disseminated around the country. Information is necessary, and I am absolutely certain that some health districts are very much better supplied than others. Some years ago I had the honour to officially open the Rubella Centre in Leeds. It is amazing how handicapped some of the children are. Most are blind and deaf with severe speech defects. The staff are so dedicated that it is heartening to see them at work. They say that every child can be educated in some way. Is enough done to ensure that girls have their vaccination to prevent German measles? Would the Minister say whether a booster is necessary, and if so, at what age? I do not think that all parents know this, and I am not sure myself. This is a very important method of prevention of what can be a great impairment.

Are children followed up to have their vaccinations if they are not in school on the day the vaccination is done? What happens if they have moved schools and miss vaccination for that reason? There is a worry that there is not enough skilled speech therapy in schools where there are handicapped children with speech defects. This fear has been well aired tonight. Many teachers do not understand the specialised skills needed to cope with such children. They need in-service training to understand the needs of these children. If integration of handicapped children in normal schools is to be effective, there should be adequate funding to provide speech therapists and skilled teachers. Is not one of the problems the fact that funding for speech therapy comes from the Department of Health and Social Security, which means that great co-ordination and co-operation between health and education departments is necessary? They must work more closely together. If these children are to be adequately taught and their speech and language disorders catered for, this should be done.

I serve on a regional health authority and I can tell your Lordships that handicapped people come a long way down the list. I keep reminding my fellow members that help given is very well worthwhile and assists in the long run. The aphasic child needs clear and positive direction in a limited range of well defined tasks and a great deal of repetition. Great dedication and skill is needed by teachers to deal with the tasks of repetition. They have to develop attention skills and concentration as foundations of better learning. Much modern technology is now used in schools, but it is useless if the teachers do not know how to use it. It can be of the greatest benefit to children with speech problems, be they highly intelligent or mentally handicapped. After asking a question of my noble kinsman on the use of computers with handicapped children, I received some most interesting information from all over the country. The future can look bright for many handicapped people so long as what is needed is made available to them and the skills of teachers and therapists are also adequately covered throughout the country.

I have the honour to be a vice president of Action for Dysphasic Adults along with my colleague the noble Baroness, Lady Lane-Fox. I hope that this debate will have given some encouragement to the many people who do so much voluntary work to help and support both children and adults with speech defects. But we must urge that more is done to prevent these tragedies happening. High standards in maternity units are essential, so that spastic babies are not born. We should promote the wearing of safe riding hats to help prevent head injuries in riding accidents, safe crash helmets for motor cyclists, and many other safety issues.

I should like to touch on one subject which I do not think has been mentioned tonight. This is the help given by therapists to patients who have cancer of the throat. Many people will remember the bravery of people like the actor Jack Hawkins. Many people with cancer have to learn to speak again in a special way. We must have informed speech therapists to help these unfortunate people overcome these terrible problems.

8.40 p.m.

The Earl of Caithness

My Lords, my noble friend Lord Campbell of Croy said it may be inappropriate to have this debate in your Lordships' House. But I think it is highly appropriate and, as the noble Lord, Lord Ennals, pointed out, highly opportune. Therefore, I thank my noble friend Lord Campbell of Croy for introducing the debate so well.

There is no doubt whatever that impairment of the ability to speak is an extremely distressing condition which leads to very severe frustration and isolation for the sufferer and great distress to carers and friends. Indeed, all noble Lords have spoken tonight with great feeling and personal knowledge on the subject. I would also like to pay tribute to the excellent work of the speech therapy profession and the dedication, skill and care that they bring to this specialised field.

We have no firm estimates of the numbers of people with speech disorders, although the Quirk Report on Speech Therapy Services in 1972 suggested this was in the region of 300,000 and a more recent literature study indicated that it was more likely to be double that figure. One of the problems is that of definition; for example, developmental language delay in preschool children is an important condition and requires treatment.

In adult life the major causes of speech impairment are stammering, and that occurring as a result of neurological disease, particularly stroke. Stroke is the single commonest cause of severe neurological handicap in the community, and it is usually reported that about one-third of people who have suffered a stroke have some degree of speech impairment. This suggests there are about 50,000 people in the United Kingdom with this type of communication problem.

At the time of the Quirk report which was mentioned by the noble Lord, Lord Campbell of Croy, the majority of speech therapists were attached to the school health service. The 1974 reorganisation of the National Health Service brought hospital and school health speech therapy services together within the NHS and under their own professional heads of service. This organisational change coincided with a growing awareness of the relative deficiencies of service for speech and language-disordered people of all ages, and the general impetus to services for disabled people. The Quirk report recommended among other things an increase in the numbers of training places for speech therapists. The noble Lord, Lord Henderson of Brompton, will be pleased to know that these recommendations have very largely been carried out and the annual training entry has been increased beyond the level recommended by the report and 16 degree courses are now recognised for qualification purposes. Post-graduate training is also slowly being introduced by the College of Speech Therapists.

The result of all this has been to more than double the number of speech therapists employed in the National Health Service. Health authorities are trying to give as much priority as possible within their available resources to speech therapy services. There is evidence to show that the expenditure which they have devoted to these services over the last 10 years has increased annually at a much greater average rate than the general increase in Health Service expenditure as a whole. This shows that health authorities are aware of the great needs of speech-impaired people and are determined to improve the service they offer. I do not deny there is room for improvement, but great strides have been made.

The increase in their numbers and better training has enabled speech therapists to break into new ground, as mentioned by the noble Lord, Lord Campbell of Croy: for example, working together with teachers of the deaf to improve the speech of profoundly prelingually deaf children; developing new techniques for improving the speech of adults with voicing disorders, and helping the spread of signing systems such as MAKATON, and a symbol system such as BLISS, for those unable to develop speech. This latter was an extremely important development opening ways of communicating for those severely physically and mentally handicapped children and adults.

I now turn to services provided for children and for adults—spending perhaps longer on the former in view of the statutory responsibilities of health and education authorities. The early detection of all handicapping conditions is clearly vital if we are to do all we can to help children to achieve their full potential in terms of their emotional, social and educational development. In this, detection of problems of communication is particularly important.

The detection of such conditions is one of the primary aims of the community child health services. In Care in Action published in 1981, we emphasised that health authorities should have local strategies of health promotion and preventative medicine and these should include screening for disabilities in young children and adequate arrangements for child health surveillance. A programme for this surveillance was suggested in the Department's 1980 paper, Prevention in the Child Health Services. This included the need to review development of early language in children from 18 months. As a result, child surveillance programmes are being instituted in a majority of health districts. Having encouraged these programmes the next step was to improve the arrangements for identifying the needs and determine the nature of services to be provided to individual handicapped children. This is a central purpose of the Education Act 1981. The Act encompasses most of the proposals contained in the Warnock report published in 1978.

My noble friend Lord Renton will be aware that the Act provides a framework for the multi-professional assessments of the special educational needs of the child, taking into account strengths and weaknesses. Opportunities for parents to contribute to the assessment are an essential part of the process. Underlying the new arrangements is the basic principle that handicapped children should be integrated into normal schools.

It would be wrong of me to pretend that the speech therapy service provided under the Act is always adequate; indeed, to say so would be doing less than justice to the very real problems which some speech therapists face in this area. There are no immediate solutions to these problems, but they can be alleviated in at least three ways. We must encourage collaboration between the different professional staff working with individual children, for example, to ensure that a therapy programme developed by one is reinforced by others. We must encourage staff to look for new ways to make the most effective use of their skills; and we must encourage authorities to work together to review their levels of service and through joint planning look to the future deployment of services and resources to better meet the needs that are being identified. If this is done then it will do much to help overcome the problem areas.

Perhaps this is an opportune moment to say how grateful I am personally for the work of speech therapists, doctors, and nursery school teachers working in harmony, and teaching my wife and myself the work that shoud be continued at home. 1t more collaboration on a scale like this can be carried out throughout the country, there will be enormous benefits for our children.

I should like to move on now to services provided for adults, although some of what I have to say will also apply to children. There is a growing awareness of the need to change the emphasis of speech therapy away from provision in institutions and the thrust is now towards treatment and care in the community, as mentioned by the noble Lords, Lord Ennals, and Lord Attlee. Priority groups, such as the elderly, mentally handicapped and mentally ill are to be supported in the community and good access to speech therapy is to be part of that support. Some districts are therefore funding extra establishments from cost improvement schemes to help in this direction.

Therapists also accept that face to face therapy is not always the best approach and that once weekly methods of treatment were seldom more than "token" therapy. Intensive courses of treatment are being substituted and these may be planned as group therapy for patients with similar disorders on a multi-district basis. It is in the area of group therapy, too, that the voluntary sector has a major role to play.

One research study funded by the department suggested that provided programmes were directed by speech therapists, volunteers were equally as effective as therapists themselves in helping stroke patients to regain their speech. The Chest, Heart and Stroke Association, for example, have been running a Volunteer Stroke Scheme for some years now. The noble Lord, Lord Smith, in what I thought was a brilliant speech, brought this home very well to your Lordships. The scheme uses volunteers to visit patients' homes on a regular basis to help them with their speech problems. There are also weekly club nights and outings and other events. The scheme is a prime example of the statutory authority and the voluntary body working together since the CHSA pays for the first two years after which the health district meets the costs. Other voluntary bodies such as the Action for Dysphasic Adults, mentioned by the noble Baroness, Lady Lane-Fox, and my noble kinswoman Baroness Masham of Ilion with its 250 stroke clubs scattered around the country and the National Association of Laryngectomy Clubs also plays a major role in the rehabilitation of speech-impaired patients.

Like the noble Baroness, Lady Lane-Fox, and the noble Lord, Lord Smith, I cannot praise too highly the contribution made by the voluntary organisations in the field of speech disorders embracing not only the actual needs and treatment of patients, but also the counselling and other needs of their families.

I have spoken at some length about speech therapists and the service that they provide. I must, however, refer to another. For some patients whose language—that is, their understanding of the written and spoken word—is intact but who for one reason or another are incapable themselves of producing audible, understandable speech, there is hope in the communication aids. These aids, which are microprocessor based, and which were mentioned by the noble Lord, Lord Ennals, and the noble Lord, Lord Henderson of Brompton, may take a number of different forms.

The advent of the new technology was an area where central Government could help, and in 1983 the department, together with the Welsh Office and the Royal Associaton of Disability and Rehabilitation, funded six communication aids centres, five in England and one in Wales. The pioneering centre at Frenchay Hospital in Bristol had been set up earlier with voluntary money.

These centres, staffed by speech therapists, are undoubtedly making a major impact in the assessment of speech-impaired people for communication aids, recommendations for appropriate aids and switches, and for provision of information and courses for speech therapists and other professional staff concerned with speech-impaired people. There is tremendous interest in communication aids within the speech therapy profession, and speech therapists have taken to the new technology with great enthusiasm. The whole area of therapy is expanding and emphasises the benefits to patients from multidisciplinary working between speech therapists, bioengineers, doctors and occupational therapists.

Perhaps I may briefly deal with some of the points raised in the debate. My noble friend Lord Campbell of Croy asked what the department was doing about student training and student training allowances. As I appreciate my noble friend knows, the situation is that the Government liaise with the regional health authorities which then liaise with the districts. It is the districts which employ the speech therapists. We must be careful not to interfere too much in local situations which must be catered for on an individual basis. However, the DHSS door is always open and we have told the College of Speech Therapists that that is the case.

My noble friend Lord Campbell of Croy mentioned the block system in training and said that it had been stopped. As I understand it, I do not think that at the moment it has been stopped, but I shall check on that and if I am wrong, I shall write to my noble friend.

A number of noble Lords, notably the noble Lord, Lord Ennals, and my noble kinswoman Lady Masham, mentioned prevention. To a certain extent the prevention of speech and language disability in adults is part of the general health education programme, which includes such things as the antismoking campaign, the prevention of alcoholism, and high blood pressure.

Periodic screening of patients for high blood pressure has been recommended by the Royal College of General Practitioners and in the department's publication Avoiding Heart Attacks, which was published in 1981. About 90 per cent. of people see their GP at least once in five years and GPs are increasingly taking the opportunity of a routine consultation to check their patients' blood pressure.

Indeed, many GPs run regular screening programmes for their patients. This is a simple procedure but an important one in identifying some of the people at increased risk of hypertension, coronary heart disease or strokes. As my noble kinswoman said, prevention is better than cure.

In childhood the health surveillance programme in the 0 to 5 age group is of prime importance in the detection of speech and language disorder, so that early intervention helps to develop the child's full linguistic potential and thus prevents later learning difficulties. For prenatal care speech therapists and other health professionals may be involved with antenatal classes explaining the importance of early communication.

The noble Lord, Lord Ennals, specifically mentioned speech therapists and deaf children. The College of Speech Therapists has instituted a postgraduate course for speech therapists working with the hearing-impaired. The present course is full and there are applicants for two more such courses. My noble friend Lord Renton will be pleased to know that, starting in the autumn, there will be a special course for speech therapists involved with mental handicap. Complementary to this is the steady increase nationally in the number of speech therapy posts for the mentally handicapped.

The noble Lord, Lord Ennals, also mentioned radio hearing aids. This is another new development. I heard again about it on the radio this morning. I hope that the noble Lord was awake as well and listening. He was not?

Lord Ennals

My Lords, I was at work.

The Earl of Caithness

My Lords, so was I—listening to the radio. It is obviously something that has great potential for the future and we shall be looking at it carefully.

My noble kinswoman Lady Masham asked whether the DHSS had appointed a speech therapy adviser. Indeed, Mrs. Susan Swan, a London-based district speech therapist, was recently appointed speech therapy adviser to the Department of Health and Social Security. Although the appointment is on a part-time basis, I can assure my noble kinswoman that Mrs. Swan is here tonight listening to the debate.

The speech therapy services are, as I stressed earlier, an integral part of the NHS and it is the health authorities themselves which must decide how they wish to develop their services, taking into account the resources available to them and other competing demands. I think that I have demonstrated to your Lordships that in the decade since the speech therapy services became part of the NHS, health authorities have shown that they are aware of the needs of speech-impaired people and are prepared to meet those needs. I am confident that they will continue to do so.

I am also confident that the voluntary sector will continue to make its invaluable contribution to the totality of services and in particular in that area which was for so long neglected, the rehabilitation of the stroke patient.

Lord Renton

My Lords, before my noble friend sits down, I realise that I cannot ask him to commit the Government tonight, but may I ask him for an assurance that he will pass on and have considered the views expressed by me and, I think, by implication by the noble Lord, Lord Ennals, and perhaps by others, that the training and the organisation of speech therapists should become an educational responsibility, just as the teachers of the various kinds of mentally handicapped come under that aegis?

The Earl of Caithness

My Lords, I shall read very carefully, as will my noble friend Lady Trumpington and my right honourable and honourable friends in the DHSS everything that has been said tonight. If we can learn anything from what has been said, as I know we can, it will be taken into account.

Baroness Masham of Ilton

My Lords, before my noble kinsman sits down again, will be write to me about the booster vaccination for rubella?

The Earl of Caithness

; Yes, indeed. If I have not answered any noble Lord's, any noble Baroness's or my noble kinswoman's points, I shall of course do so in writing.